Mehl. Risk factors 7: renal/GI Flashcards
(116) 4M + low Hb + Hx of diarrhea after meals; Dx + risk factor for the anemia?
Celiac disease; major risk factor for anemia in peds (flattening of villi causes impaired iron absorption in duodenum.
(117) 4M + recent gastroenteritis + now has diarrhea after meals; Dx + risk factor?
lactose intolerance; risk factor is recent GI viral infection; the latter can cause transient lactose intolerance due to sloughing of brush border (hence losing disaccharidase).
(118) 4M + small, shrunken kidney + tubular atrophy seen on biopsy; Dx + risk factor?
chronic pyelonephritis; major risk factor is recurrent acute pyelo, either from vesicoureteral reflux or posterior urethral valves (can be written on NBME as “congenital urethral obstruction”).
(119) 8F + puffy eyes and ankles + ascites + protein in urine; Dx + risk factor?
minimal change disease; risk factor is viral infection; if presents in adult, can be Hodgkin lymphoma.
(120) 27M + sickle cell + nephrotic syndrome; Dx + risk factor?
focal segmental glomerulosclerosis caused by sickle cell; in short, FSGS is the answer if patient has nephrotic syndrome in sickle cell. Can also rarely be caused by HIV / heroin use.
(121) 27M + sickle cell + dark urine; Dx + risk factor?
renal papillary necrosis; this is answer on USMLE if patient has blood in the urine in sickle cell.
(122) 26F + IV drug user + recently treated with 6 weeks of nafcillin for MSSA endocarditis + now has rash and eosinophils in the urine; Dx + risk factor for renal condition?
interstitial nephropathy (aka tubulointerstitial nephropathy/-nephritis); risk factor is beta-lactam, cephalosporin, or NSAID; answer on USMLE if patient gets WBCs (eosinophils) in urine +/- maculopapular rash following any of the aforementioned drugs; these agents do not classically cause acute tubular necrosis.
(123) 26F + IV drug user + develops oliguria following gentamicin and vancomycin empiric Tx for endocarditis; Dx + risk factor?
acute tubular necrosis due to gentamicin (aminoglycoside).
(124) 38F + rheumatoid arthritis + took gold salts for treatment + develops proteinuria; Dx + risk factor?
gold salts causing membranous glomerulonephritis; dapsone can also cause this.
(125) 40F + history of hepatitis B + proteinuria; Dx + risk factor?
membranous glomerulonephritis due to hepatitis B; this is renal Dx if patient has nephrotic syndrome in setting of hepatitis B or C.
(126) 40F + history of hepatitis C + blood in urine; Dx + risk factor?
membranoproliferative glomerulonephritis; this is answer on USMLE if patient has nephritic syndrome in hepatitis B or C.
(127) 45M + various medium-sized arteries with fibrinoid necrosis and segmental, beaded, “rosary sign”; diagnosis + risk factor?
polyarteritis nodosa; major risk factor is hepatitis B (30% of patients with PA are seropositive for HepB).
(128) 40F + SLE + blood in urine; Dx + risk factor?
diffuse proliferative glomerulonephritis due to SLE; answer on USMLE if patient has nephritic syndrome in SLE; if nephrotic syndrome in SLE, patient just has regular membranous glomerulonephritis. But DPGN is»_space;> higher yield for SLE.
(129) 12F + blood in urine 1-3 days after sore throat; Dx + risk factor?
IgA nephropathy; answer on USMLE when patient has blood in urine 1-3 days following sore throat (viral infection).
(130) 12F + blood in urine 1-3 weeks after sore throat; Dx + risk factor?
PSGN is answer on USMLE when patient has blood in urine 1-3 weeks following sore throat (group A strep infection).
(131) 50M + flank pain + blood in urine + high serum calcium + high hemoglobin; Dx + risk factor?
renal cell carcinoma; major risk factor is smoking; can produce ectopic PTHrp (similar to squamous cell of lung) and EPO.
(132) 50M + blood in urine + Hx of smoking; Dx + risk factor?
bladder cancer (transitional cell carcinoma); major risk factor is smoking. Aniline dyes (industrial dyes) and naphthylamine (moth balls) are also assessed for causing transitional cell carcinoma of bladder.
(133) 23M + swam in lake in Africa + now has blood in urine; Dx + risk factor?
squamous cell carcinoma of the bladder due to Schistosoma hematobium; risk factor is swimming in fresh water in Africa.
(134) 40M + comes back from Africa with hemolytic condition + image shows schizonts of malaria; Q asks
what patient is at greatest risk for?
answer = hypoglycemia; you need to know malaria (particularly P. falciparum) can lead to hypoglycemia. If you think it’s weird, don’t take it up with me. It’s on one of the Step 1 NBME exams.
(135) 7F + running around barefoot in rural Louisiana + gets microcytic anemia + high eosinophils; Dx + risk factor?
Dx = hookworms; risk factor is running around barefoot (USMLE wants you to know you get them through your feet, not from food); they cause microcytic anemia.
(136) 60F + low serum sodium + concentrated urine + history of weight loss; Dx + risk factor?
SIADH due to small cell lung cancer; smoking is risk factor.
(137) 60F + high calcium + lung cancer; Dx + risk factor?
squamous cell carcinoma secreting PTHrp.
(138) 60F + lung cancer + difficulty getting up from chair a few times; Dx + risk factor?
Lambert-Eaton due to small cell (anti-presynaptic voltage-gated Ca channel antibodies).
(139) 60F + lung cancer + ataxia; Dx + risk factor?
small cell cerebellar dysfunction (anti-Hu/-Yo) Abs.
(140) 35F + worsening diplopia, dysphagia, and eyelid ptosis over the course of a day; Dx and risk factor?
myasthenia gravis (Abs against post-synaptic nicotinic acetylcholine receptors); often idiopathic, but
can be due to thymoma as risk factor.
(141) 35F + ovarian mass + purple discoloration of knuckles + violaceous eyelids + proximal muscle
weakness; Dx + risk factor?
dermatomyositis due to ovarian cancer. Dermatomyositis usually idiopathic, but a risk factor for it that’s assessed is ovarian cancer.
(142) 64F + back pain + nephrotic syndrome + S4 heart sound; Dx + risk factor?
renal amyloidosis and cardiac amyloidosis; major risk factor for amyloidosis on USMLE is multiple myeloma.
(143) 2M + enucleation of eye for retinoblastoma; Q asks about this being risk factor for which of the following in the future?
answer = osteosarcoma; hereditary retinoblastoma can also lead to osteosarcoma.
